[Effect of portal vein thrombosis on the long-term prognosis of patients with hepatitis B cirrhosis].

Q3 Medicine
K K Jin, Y Han, Y J Yan, L N Lyu, Y N Liu, Y L He, H G Ding
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引用次数: 0

Abstract

Objective: To explore the characteristics of portal vein thrombosis (PVT) formation in patients with hepatitis B cirrhosis and its effect on long-term prognosis. Methods: The clinical data of a cohort of patients with hepatitis B cirrhosis who visited Beijing Youan Hospital from May 2009 to August 2020 were retrospectively analyzed. Enhanced CT examination was used as the standard for diagnosing PVT and its classification. Patients with hepatitis B cirrhosis without PVT at baseline were selected as the research subjects. According to whether PVT was formed during the follow-up period, they were divided into the PVT and control groups including 99 and 168 patients in the PVT and control groups with a follow-up time of 52.0 (46.7, 57.3) months. The changes in baseline and endpoint clinical indicators of the two groups were compared. Kaplan-Meier survival curve, log-rank test, and Cox regression were used to analyze the effect of PVT on prognosis. Results: In the PVT group, 28.28% (28/99) of patients underwent splenectomy, and 74.75% (74/99) did not receive anticoagulation therapy. The main portal vein thrombosis, portal vein branch thrombosis, and thrombosis in both groups accounted for 34.34% (34/99), 23.23% (23/99), and 15.15% (15/99), respectively. The splenic vein or superior mesenteric vein accounted for 27.27% (27/99). PVT was stable in 63.27% (63/99), progressed in 31.31% (31/99), and relieved in 5.05% (5/99) during the follow-up period. The white blood cell, hemoglobin, and platelet counts were all decreased in the PVT group compared with the baseline (P<0.05). The international normalized ratio (INR) [1.28 (1.14, 1.39) vs. 1.33 (1.19, 1.46), P=0.041] and spleen length [(163.84±30.68) mm vs. (177.26±32.61) mm, P<0.001] was increased compared with the baseline. The proportion of gastroesophageal variceal bleeding was higher in the PVT group than in the control group (57.0% vs. 28.7%, P<0.001), and the constituent ratio of hepatic encephalopathy was not statistically significantly different (P>0.05). The proportion of patients with ascites in the control group decreased (63.1% vs. 41.7%, P<0.001), while the proportion of patients with ascites in the PVT group was not statistically significantly different (P>0.05). The incidence of composite clinical endpoint events in the PVT and the control group was 21.21% (21/99) and 4.17% (7/168), respectively (P<0.05). The incidence of composite clinical endpoint events in PVT patients without anticoagulation and anticoagulation treatment was 25.68% (19/74) and 8.00% (2/25), respectively (P=0.062). Cox regression analysis found that PVT formation was an independent risk factor for liver-related adverse events in patients with hepatitis B cirrhosis (HR=9.36, 95%CI: 3.65~24.02, P=0.001). Conclusions: The presence of PVT in patients with hepatitis B cirrhosis is assoliated with worse prognosis. The formation of PVT is closely related to the increased risk of liver-related adverse prognosis in patients with hepatitis B cirrhosis.

[乙型肝炎相关性肝硬化患者门静脉血栓形成的长期预后意义]。
目的分析乙肝相关肝硬化患者门静脉血栓形成(PVT)的特征及其对长期预后的影响。方法:分析 2009 年 5 月至 2020 年 8 月期间乙肝相关肝硬化患者的临床数据,并采用增强 CT 检查对门静脉血栓进行诊断和分类。基线时无 PVT 的乙肝相关肝硬化患者也被纳入研究。随访终点事件为肝病相关死亡、肝移植、肝癌或随访至2023年12月31日。在随访期间,根据是否存在 PVT 将患者分为 PVT 组和对照组。比较两组患者在基线和终点时间的临床数据变化,并采用 Kaplan-Meier 生存曲线、Log-rank 检验和 Cox 回归分析评估 PVT 对预后的影响。结果共纳入 267 例乙肝相关肝硬化患者,中位随访时间为 52.0(46.7,57.3)个月。PVT组有99名患者,对照组有168名患者。在 PVT 组中,28.28%(28/99)的患者切除了脾脏,74.7%(74/99)的患者没有接受抗凝治疗。34.3%(34/99)、23.2%(23/99)和15.2%(15/99)的患者发现门静脉主干血栓形成、门静脉分支血栓形成,其中27.3%(27/99)的患者涉及脾静脉或肠系膜上静脉。在随访期间,63.6%(63/99)的 PVT 病例病情保持稳定,31.3%(31/99)病情有所进展,5.1%(5/99)病情有所缓解。在 PVT 组中,白细胞、血红蛋白和血小板计数显著下降(PP=0.041],脾脏长度增加[163.84±30.68 mm vs. 177.26±32.61 mm,PPP>0.05]。对照组腹水患者比例降低(63.1% vs. 41.7%,PPP>0.05)。PVT组综合临床终点事件发生率为21.2%(21/99),对照组为4.2%(7/168)(PP=0.062)。Cox回归分析显示,PVT的形成是乙肝肝硬化患者发生肝脏相关不良事件的独立风险因素(HR=9.36,95%CI:3.65-24.02,P=0.001)。结论乙肝相关肝硬化中 PVT 的形成与肝脏相关不良后果风险的增加密切相关。应重视对乙肝肝硬化患者进行 PVT 筛查和早期预防。
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来源期刊
中华肝脏病杂志
中华肝脏病杂志 Medicine-Medicine (all)
CiteScore
1.20
自引率
0.00%
发文量
7574
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